Expert Consensus Building using e-Delphi for Necrotizing Enterocolitis Risk Assessment

Objective To confirm content validity of GutCheckNEC, a risk index for necrotizing enterocolitis (NEC) and to determine the level of agreement among experts about NEC risk factors in premature infants. Design Electronic Delphi method (e-Delphi). Setting Online electronic surveys and e-mail communication supported by an interactive study website. Participants Nurses and physicians (N=35) from four countries and across the United States who rated themselves as at least moderately expert about NEC risk. Methods e-Delphi involved three rounds of surveys and qualitative thematic analysis of experts' comments. Surveys continued until criteria for consensus and/or stability were met. Results Of 64 initial items, 43 were retained representing 33 risk factors (final GutCheckNEC Content Validity Index [CVI]=.77). Two broad themes about NEC risk emerged from 242 comments: the impact of individual physiologic vulnerability and variation in neonatal intensive care unit (NICU) clinicians' practices. Controversy arose over the impact of treatments on NEC, including probiotics, packed red blood cell (PRBC) transfusions, and patent ductus arteriosus (PDA) management using indomethacin. Conclusion GutCheckNEC achieved borderline content validity for a new scale. The e-Delphi process yielded a broad perspective on areas in which experts share and lack consensus on NEC risk. Future testing is underway to reduce the number of risk items to the most parsimonious set for a clinically useful risk tool and test reliability.